Toner M, Condell D, O'Briain D S
Histopathology Department, St. James's Hospital, Dublin, Ireland.
Am J Surg Pathol. 1990 Aug;14(8):719-28.
The term "obstructive colitis" refers to ulceroinflammatory lesions occurring in the colon proximal to an obstructing or potentially obstructing lesion. We studied nine cases identified over a 9-month period. The patients were predominantly female (only one was male), elderly (mean age, 73), and usually had hypertension, diabetes, or other prior chronic illness. The colonic obstruction was due to adenocarcinoma in seven cases and to diverticular disease in two cases. Areas of colitis occurred either as circumscribed ulcers 0.5-2 cm in diameter (three cases) or as confluent circumferential lesions 8-25 cm in length; they were always separated from the more distal obstructing lesions by a segment of normal colon measuring 2.5-35 cm (mean, 14.6 cm). The involved area of colon was usually only mildly dilated; it exhibited moderate thickening of the wall and had a granular luminal surface accentuated in areas by deeper longitudinal or transverse ulcers. Often there were scattered pseudopolyps, and the margin separating the lesion from normal mucosa was well demarcated and irregular. In one case, two distinct separate areas of colitis were present; in another, the appendix was acutely inflamed. Microscopically, the lesions were composed of granulation tissue with a mixed acute and chronic inflammatory infiltrate that replaced the mucosa and often the submucosa; sometimes it extended into the muscularis propria, with associated peritonitis and perforation. Many of the features of obstructive colitis suggest an ischemic origin, probably mainly due to hypoperfusion following raised intramural pressure, but altered fecal flora may have a synergistic effect. The features of the disease are usually sufficiently characteristic to distinguish it from Crohn's disease and other forms of colitis. Complications include peritonitis, perforation and breakdown of anastomoses made through involved segments of colon that may appear externally normal at surgery.
“梗阻性结肠炎”一词指发生在梗阻性或潜在梗阻性病变近端结肠的溃疡性炎症病变。我们研究了在9个月期间确诊的9例病例。患者以女性为主（仅1例为男性），年龄较大（平均年龄73岁），且通常患有高血压、糖尿病或其他既往慢性疾病。结肠梗阻7例由腺癌引起，2例由憩室病引起。结肠炎区域表现为直径0.5 - 2厘米的局限性溃疡（3例）或长度为8 - 25厘米的融合性环周病变；它们总是与更远端的梗阻性病变被一段2.5 - 35厘米（平均14.6厘米）的正常结肠隔开。受累结肠区域通常仅轻度扩张；其肠壁表现为中度增厚，管腔表面呈颗粒状，在较深的纵向或横向溃疡区域更为明显。常有散在的假息肉，病变与正常黏膜的边界清晰且不规则。1例患者存在两个明显分开的结肠炎区域；另1例患者阑尾急性发炎。显微镜下，病变由肉芽组织构成，伴有急性和慢性混合性炎性浸润，取代了黏膜，且常累及黏膜下层；有时炎症扩展至固有肌层，伴有腹膜炎和穿孔。梗阻性结肠炎的许多特征提示其起源于缺血，可能主要是由于壁内压力升高后的灌注不足，但粪便菌群改变可能具有协同作用。该疾病的特征通常具有足够的特异性，可将其与克罗恩病和其他形式的结肠炎区分开来。并发症包括腹膜炎、穿孔以及通过受累结肠段进行的吻合口破裂（在手术时结肠外部可能看似正常）。
